Invasive procedures can be distressing for the child, family and carers. With preparation and support children can learn coping strategies and build resilience.
The need for invasive procedures is kept to a minimum. Procedures should be performed in the least painful and stressful way. The child, parent and carer will need anticipatory guidance to ensure the child is fully supported to learn coping strategies. Despite this, it is inevitable that through the course of their treatment (and especially around the time of diagnosis) the child or young person (CYP) and their family will have to cope with an invasive procedure that they find distressing. It is often worse when the child is feeling physically unwell at the same time, when their resilience is low.
The CYP will, whenever possible, be prepared in advance for what is to be done and what to expect. There is a range of techniques that can be employed to make painful or uncomfortable procedures more bearable. These include play preparation, distraction, numbing cream, solutions to dissolve adhesive dressings, stickers and a choice of a present from the “treat box” after a procedure.
Factors to consider when offering anticipatory guidance and preparation
- The age and developmental stage of the child.
- The presence of additional needs (e.g. learning disabilities, autism, ADHD, neurodiversity, sight or hearing impairment).
- Timing. Preparation too far in advance of the procedure will be meaningless to some children, especially younger ones.
- Role and skills of the workforce. Nurses and health play specialists may be helpful in many situations, but some unusual procedures may need to involve other AHPs with more detailed knowledge of the procedure.
- Assessment of how the child usually copes, likes and dislikes, preferences, how much choice and control can this procedure allow.
- Parental knowledge and experience of their child.
- Tools and resources available.
As soon as possible, all patients requiring repeated intravenous access will have a central venous access device (CVAD) inserted; this reduces the need for peripheral cannula. Throughout treatment, injections are kept to a minimum, where possible. Lumbar punctures and bone marrow aspirates are usually performed under general anaesthetic, as is the insertion of a CVAD. Some CYP, particularly those with Acute lymphoblastic leukaemia (ALL), require many lumbar punctures throughout their treatment. Some older children and young people choose to have their lumbar punctures under local anaesthetic to avoid fasting and the longer day that going to theatre entails.
Parents and carers who are well prepared and supported by staff during difficult procedures will find it easier to support their child. If the parent or carer can be present and supportive of their child, the child usually finds it easier to cope. However, parental anxieties can have an impact on the child or young person’s own anxieties and alternative support for the child may be offered by the multidisciplinary team. If a parent or carer does not wish to stay during a procedure, they must always have that choice and be reassured that staff will help their child and call them in as soon as it is finished.
Tools and resources
Health play specialists will have a range of tools and resources to help prepare children for procedures. These may include picture books, Lego models or other scale models, toy hospital equipment, virtual reality headsets, and relaxation techniques. Some Trusts and organisations have developed Apps and video content to aid preparation.
The Oncology Guide- Procedures
Many of the treatment centres have introduced a Bead trail as an extra therapeutic strategy helping the child to focus on getting the bead once the procedure is over. Toys are available for the child or young person such as ‘Chemo Ducks’ and ‘Olly the Brave’ which have central lines the CYP can relate to and practise play with. Hospitals employ a range of the above methods to strive to reduce the impact of invasive procedures. However, it is also acknowledged that treatment for cancer is difficult and the extent to which a child or young person manages, depends on their own and their family’s individual coping strategies.
A CYP with additional needs may have their own ‘Hospital Passport’ which can contain details about the child, their diagnosis, but also the best techniques, environments and ways of explaining things to them, to aim to make procedures less stressful. It is important anyone involved with the child reads their passport to help them cope with invasive procedures (Together for Short Lives, 2025).
Debriefing is important
The time after a procedure is as important as the preparation for it. The child should be given time to recover adequately from the procedure, such as being able to eat and drink again, taking a nap, receiving adequate analgesia if the procedure was painful, adjusting to new equipment such as an NG tube, central line, or cannula. Once these practical elements are covered, it is valuable to take time to ask the child how it went so that they, their parents and carers, and the healthcare team can be better equipped if this or similar procedures are needed again in future. Explore what was ok and not as bad as they expected, what didn’t go well or was worse than they expected, what they think could be done differently.
Give praise, especially if they tried hard to stay still, for example. Remind them it’s OK to cry and feel scared, but reinforce how well they did with deep breathing, hugging their parent, focusing on the distraction, etc. Find things they can feel proud of, for example, can they tell their grandparent how well they did and show them their reward sticker or ‘Bead.’
Include the parent and care givers’ feelings of how things went and what could be better next time. Is there any other information or preparation they or their child needs.
If they child was physically unwell at the time of the procedure or things went badly, make sure they and their family know this does not always mean it will be like this. Continue to work together on preparation, and record what was learned for next time. It is often helpful to suggest the parent makes a note as they may be the consistent support at later events.
Last reviewed February 2026